Attachment B Central Forms

Maternal and Child Health Bureau Performance Measures for Discretionary Grant Information System (DGIS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0298 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Attachment B Central Forms Form and Instruction
1 Attachment B DGIS OMB DGIS OMB_SSA_Attachment B_Central Forms_CLEAN.docx Form and Instruction
1 Attachment B DGIS OMB DGIS OMB_SSA_Attachment B_Central Forms_CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment B Central Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Attachment B DGIS OMB	DGIS OMB_SSA_Attachment B_Central Forms_CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,642	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,642	6,642
Annual IC Time Burden (Hours)	14,776	14,776
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.